title: Automated quality measurement in Department of the Veterans Affairs discharge instructions for patients with congestive heart failure.
abstract: Quality measurement is an important issue for the United States Department of Veterans Affairs (VA). In this study, we piloted the use of an informatics tool, the Multithreaded Clinical Vocabulary Server (MCVS), which extracted automatically whether the VA Office of Quality and Performance measures of quality of care were met for the completion of discharge instructions for inpatients with congestive heart failure. We used a single document, the discharge instructions, from one section of the medical records for 152 patients and developed a reference standard using two independent reviewers to assess performance. When evaluated against the reference standard, MCVS achieved a sensitivity of 0.87, a specificity of 0.86, and a positive predictive value of 0.90. The automated process using the discharge instruction document worked effectively. The use of the MCVS tool for concept-based indexing resulted in mostly accurate data capture regarding quality measurement, but improvements are needed to further increase the accuracy of data extraction.
authors.affiliation: Department of Biomedical Informatics, University of Utah School of Medicine, UT, USA. jennifer.garvin@hsc.utah.edu
authors.forename: Jennifer H
authors.initials: JH
authors.lastname: Garvin
authors.forename: Peter L
authors.initials: PL
authors.lastname: Elkin
authors.forename: Shuying
authors.initials: S
authors.lastname: Shen
authors.forename: Steven
authors.initials: S
authors.lastname: Brown
authors.forename: Brett
authors.initials: B
authors.lastname: Trusko
authors.forename: Enlai
authors.initials: E
authors.lastname: Wang
authors.forename: Linda
authors.initials: L
authors.lastname: Hoke
authors.forename: Ylenia
authors.initials: Y
authors.lastname: Quiaoit
authors.forename: Joan
authors.initials: J
authors.lastname: Lajoie
authors.forename: Mark G
authors.initials: MG
authors.lastname: Weiner
authors.forename: Pauline
authors.initials: P
authors.lastname: Graham
authors.forename: Theodore
authors.initials: T
authors.lastname: Speroff
mesh_terms: D006333:Heart Failure / Q000534:rehabilitation*; D006787:Hospitals, Veterans / Q000592:standards*; D006801:Humans; D008491:Medical Informatics Applications; D010043:Outcome and Process Assessment, Health Care / Q000379:methods*; D010351:Patient Discharge / Q000592:standards*; D010353:Patient Education as Topic / Q000379:methods / Q000592:standards*; D010865:Pilot Projects; D019984:Quality Indicators, Health Care; D039061:Systematized Nomenclature of Medicine; D014481:United States; D014493:United States Department of Veterans Affairs
keywords: evaluation of health information technology; natural language processing (NLP); performance measurement